Wednesday, June 15, 2011

Buprenorphine Pain Patch

Peter R. Coleman, M.D.

Recently some drug reps from Purdue Pharma came to let us know about a new pain patch that has come on the market. It is called Butrans and is available in three different strengths. It contains the drug Buprenorphine. The Buprenorphine is delivered in fairly low doses, but it is provided in a steady dose for a whole week. It has been found that when the drug is delivered in this way over an extended time, it is not necessary to use very high doses.

Butrans has been studied in patients with moderate to severe chronic pain. Usually patients have been switched from other opiate drugs and continued on the patch. The results have shown that about 60% of patients were able to switch to the patch. The studies lasted about 12 weeks. There were two studies that did not show that the Butrans patch had any pain relieving value, but in one of the studies the other opiate it was compared to had no value either.

One of the advantages of a steady patch like this is that patient will get a steady dose of the medicine and be less likely to abuse it. We see this with Fentanyl pain patches and it really is a big advantage when so many patients take more of their medicines than are prescribed.

There are a couple of negatives about this drug. First, it is only strong enough to treat pain for patients who are on quite low doses of other opiates. So, the very patients that we worry will abuse their medicines are not going to be able to take this patch. Second, we don’t know if the pain relief that was seen in the short-term studies will last for months or years. Third, we don’t know if there will be major problems with withdrawal when it is time to stop the patch. The patch is also very expensive when compared to short-acting opiates like hydrocodone.

It is good to have another medicine we can use for pain patients. It will be interesting to see if it finds much of a use in clinical practice.